Factors that predict good Active Support in services for people with intellectual disabilities: A multilevel model

Abstract

Background: Active Support, now widely adopted by disability support organizations, is difficult to implement. The study aim was to identify the factors associated with good Active Support.Methods: Data on service user and staff characteristics, quality of Active Support and practice leadership were collected from a sample of services from 14 organizations annually for between 2 and 7 years, using questionnaires, structured observations and interviews. Data were analysed using multilevel modelling (MLM). Results:Predictors of good Active Support were adaptive behaviour, practice leadership, Active Support training, and time since its implementation. Heterogeneity, having more than six people in a service and larger organizations were associated with lower quality of Active Support. Conclusions:In order to ensure that Active Support is consistently implemented, and thus, quality of life outcomes improved, organizations need to pay attention to both service design and support for staff through training and practice leadership. K E Y W O R D S active support, engagement, Implementation, multilevel model, practice leadership, supported accommodation, training [Correction added on 16 November 2019, after first online publication: the affiliation of Shane Kavanagh was incorrect and has been corrected in this current version.] | 335 Published for the British Institute of Learning Disabilities BIGBY et al. Support and changes in residents' depressive symptoms, challenging behaviour, adaptive skills, choice and community participation were reported across studies, Flynn et al.'s (2018) meta-analysis did not demonstrate convergence on the direction or significance of change for any of these factors. The evidence, albeit limited, of an association between Active Support and reduction in challenging behaviour suggests its complementarity to behavioural support strategies. For example, Ockendon, Ashman, and Beadle-Brown (2017) argued that Active Support is a foundational element of Positive Behaviour Support (PBS), setting the context for its successful implementation, and McGill, Ashman, and Beadle-Brown (2014) demonstrated Active Support as an integral component of PBS, which was associated with reductions in challenging behaviour. From a staff perspective, Active Support has been found to be associated with increased staff job satisfaction and a lower propensity for staff to leave their employment (Beadle-Brown, Hutchinson, & Whelton, 2012; Rhodes & Toogood, 2016). | 343Published for the British Institute of Learning Disabilities BIGBY et al.providing coaching to develop nuanced skills in supporting service users with varied ability levels. Strong practice leadership could also maximize the potential of Active Support, as an integral part of PBS, in improving the quality of life of service users with challenging behaviours. | CON CLUS IONSThe contributions of this study emanate from being the largest investigation into Active Support in services in Australia and in evaluating the multilevel nature of factors at individual ...

Predicting good Active Support for people with intellectual disabilities in supported accommodation services: Key messages for providers, consumers and regulators

“…Somewhat unexpectedly, factors predictive of Active Support in previous studies drawn from overlapping data sets (Bigby et al, 2019a;Bould et al, 2019) were not predictive in this study: these were whether or not staff had been trained in Active Support and homogeneity of service users (the number of ABS groups represented within a service) at the service level, and organisational size and time since adopting Active Support, at the organisational level. The limited variability in this data set, compared to the two earlier ones, provides the most plausible explanations for these differences.…”

“…For this study, the presence or absence of each of these features in an organisation was derived from interviews with senior organisational leaders previously reported in Bigby et al (2019b). The present study has also confirmed findings from two earlier studies that good Active Support is predicted, at the individual level, by higher adaptive behaviour of service users, and, at the service level, by stronger practice leadership, and having six or fewer service users in a service (Bigby et al, 2019a;Bould et al, 2019). In addition, staff with a more positive perception of the quality of management was also predictive of good Active Support.…”

“…Flynn et al (2018), in a review of 10 studies, found the strongest evidence about predictors of Active Support was in respect to training (classroom combined with in-situ methods), relatively low staff-to-service user ratios and larger services (maximum of six service users), and management processes, such as team meetings. More recently, a large Australian study that applied multilevel modelling found predictors of good Active Support were the individuals' adaptive behaviour, strength of frontline practice leadership, staff training in Active Support, and time since Active Support was implemented (Bigby, Bould, Iacono, Kavangh, & Beadle-Brown, 2019a). Similar predictors were found in a study of increases in the quality of Active Support over time, which included repeated measures from the same 51 services in eight organisations over periods of two to seven years (Bould, Bigby, Iacono, & Beadle-Brown, 2019).…”

“…The limited variability in this data set, compared to the two earlier ones, provides the most plausible explanations for these differences. Unlike in the previous studies (Bigby et al, 2019a;Bould et al, 2019), data were collected at one rather than multiple time points, and at a time when all organisations had been implementing Active Support and monitoring progress annually over a number of years.…”

Quality of practice in supported accommodation services for people with intellectual disabilities: What matters at the organisational level

“…Flynn et al (2018) found tentative evidence from a synthesis of 10 studies about experiences of implementing Active Support for the positive effect of combined classroom and in-situ staff training, services with relatively low staff-to-service user ratios and larger services (to a maximum of six service users), and management processes, such as team meetings. Lending greater support to findings of earlier research, Bigby, Bould, Iacono, Kavangh, and Beadle-Brown (2019) and Bould, Bigby, Iacono, and Beadle-Brown (2019) recently demonstrated the positive influence of strong frontline practice leadership in services on implementation of Active Support leadership.…”